Pain Relief Medications: Are They Good for You?

Nonsteroidal anti-inflammatory drugs (NSAIDs) have received press in the past for their association with dangerous side effects among older adults compared to younger people.
Many older people take NSAIDs to get relief from pain, stiffness, and inflammation. However, these medications can have side effects. If you are taking NSAIDs, check the US Food and Drug Administration's (FDA)
website for medication guide
for more information.

Gastrointestinal Problems

Gastrointestinal problems, including stomach pain,
ulcers, and bleeding of the stomach lining, are potential side effects among people who take NSAIDs on a regular basis. Often the first indication of gastrointestinal damage in seniors is bleeding, which can occur without the warning symptoms of nausea, abdominal pain, diarrhea, or
dyspepsia
(indigestion and gas).

Other Problems

Lightheadedness, drowsiness, confusion, ringing of the ears, and
anxiety
can occur, all of which usually disappear once the drugs are stopped.

Because NSAIDs interfere with blood clotting, some people who take high doses of NSAIDs bruise easily. If you take blood thinners, such as aspirin or warfarin, consult with your doctor before starting NSAIDs.

Allergic reactions to NSAIDs are not uncommon. Signs of a drug allergy include rapid heartbeat, rapid breathing, wheezing, fainting,
hives
or rash, and puffiness around the eyes.

The effectiveness of antihypertensive drugs may be limited and cause diastolic blood pressure to rise with NSAID use.

There is a risk for
heart failure
in seniors who take diuretics and NSAIDs.

NSAIDs are associated with
toxic hepatitis, an inflammation of the liver which can lead to liver damage.

NSAIDs can reduce the effects of ACE inhibitors, beta-blockers, and thiazide diuretics. NSAIDs can also increase the risk of toxicity from digoxin.

Why Seniors Are at Increased Risk

People at older ages usually need more medications, and sometimes at higher doses.

The following changes are a primary reason why drug doses for seniors are typically lower than those recommended for younger people:

The liver is the body's central processing plant for drugs. As we age, the liver decreases in size, which means blood flow declines and processing slows.

The amount of body fat increases while the amount of lean body mass and total body water decrease. These changes result in a higher concentration of drugs in the body fluids and hinder drug elimination.

The kidneys help eliminate drugs from the body, but their work is slowed by declining kidney function. If you have kidney problems, use of NSAIDs should be avoided or monitored closely by your doctor.

How to Protect Yourself

Consult your physician before taking NSAIDs (or any other drug).

Take NSAIDs with food to help prevent gastrointestinal upset.

Keep a list of medications handy when you need to share drug information with your doctor or pharmacist.

Talk with your doctor about alternative pain relievers, including acetaminophen or herbal medications. All drugs have the potential for interaction and side effects.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Pharmacokinetics in the elderly. Merck Manual Professional Version website. Available at:
http://www.merckmanuals.com/professional/geriatrics/drug-therapy-in-the-elderly/pharmacokinetics-in-the-elderly. Updated June 2014. Accessed April 17, 2015.

Physical changes with aging. Merck Manual Professional Version website. Available at:
http://www.merckmanuals.com/professional/geriatrics/approach-to-the-geriatric-patient/physical-changes-with-aging. Updated July 2013. Accessed April 17, 2015.